Provider Demographics
NPI:1730723859
Name:CHOULRAMOUNTRY, KATY MARIE (FNP)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:MARIE
Last Name:CHOULRAMOUNTRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:KATY
Other - Middle Name:MARIE
Other - Last Name:BEWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1134 CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-1229
Mailing Address - Country:US
Mailing Address - Phone:469-660-4606
Mailing Address - Fax:
Practice Address - Street 1:10640 STEPPINGTON DR APT 3106
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-4620
Practice Address - Country:US
Practice Address - Phone:469-660-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX758063163W00000X
TXAP143241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP143241OtherTEXAS BOARD OF NURSING
F08190802OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS